title: Atrial fibrillation practice patterns among cardiac electrophysiologists and cardiologists.
abstract: BACKGROUND
  Treatment paradigms for atrial fibrillation (AF) are highly variable. This study explores the management practices for AF between general cardiologists and electrophysiologists in an academic institution.
  
  
  METHODS
  One hundred and eighty eight patients with AF who had primary outpatient evaluation by either a cardiologist (n = 94) or electrophysiologist (n = 94) in 2008 were selected from the Northwestern electronic medical record and included in the study. Chart review was used to determine the type of therapy, methods of monitoring AF, antiarrhythmic drug use patterns and outcome.
  
  
  RESULTS
  Patients seen by cardiologists vs. electrophysiologists were older (70.3 ± 11.8 vs. 65.3 ± 10.3, p = 0.002) and had more diabetes (21.3% vs. 10.6%, p = 0.046), renal disease (29.0% vs. 9.2%, p = 0.001) and coronary artery disease (40.4% vs. 23.4%, p = 0.01). A rate control strategy was used more often (80.9% vs. 54.3%, p < 0.001), and antiarrhythmics were prescribed less (10.6% vs. 31.9%, p < 0.001) by cardiologists than electrophysiologists. Antiarrhythmic choices were amiodarone (33.3%), sotalol (20.0%), flecainide (13.3%), propafenone (13.3%), and dofetilide (23.3%) for electrophysiologists, and were limited to amiodarone (80%) and sotalol (20%) for cardiologists. After a mean follow-up of 14.0 ± 11.6 and 12.8 ± 11.1 months (p = 0.44) for patients managed by cardiologists and electrophysiologists, mortality was 13.8% and 6.4% (p = 0.09), respectively. Long-term ambulatory electrocardiogram monitoring was used more frequently by electrophysiologists (74.4%) than by cardiologists (55.6%, p = 0.15).
  
  
  CONCLUSIONS
  Practice patterns for treatment of AF significantly differ between electrophysiologists and cardiologists. Understanding specialist treatment patterns will help optimize individualized therapy for treatment of AF.
authors.affiliation: Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States. tonyeteme@gmail.com.
authors.forename: Tonye
authors.initials: T
authors.lastname: Teme
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Goldberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000628:therapy*; D002309:Cardiology; D019468:Disease Management; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000592:standards*; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D013997:Time Factors; D000078329:Workforce